Reversal of pulmonary hypertension after ligation of a brachiocephalic arteriovenous fistula.

The arteriovenous (AV) fistula is the access method of choice for long-term hemodialysis according to DOQI guidelines. Among the recognized complications of upper extremity AV fistulae fashioned for hemodialysis are infection, aneurysm formation, and high-output left ventricular failure. We describe a novel cardiopulmonary complication--secondary pulmonary hypertension resulting from an aneurysmal brachiocephalic AV fistula. The clinical presentation, investigation, management, and pathophysiology of this complication are discussed.